Symptoms

It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability—common and nonspecific adolescent behavior. Other factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop schizophrenia, this stage of the disorder is called the “prodromal” period.

With any condition, it’s essential to get a comprehensive medical evaluation in order to obtain the best diagnosis. For a diagnosis of schizophrenia, some of the following symptoms are present in the context of reduced functioning for a least 6 months:

Hallucinations. These include a person hearing voices, seeing things, or smelling things others can’t perceive. The hallucination is very real to the person experiencing it, and it may be very confusing for a loved one to witness. The voices in the hallucination can be critical or threatening. Voices may involve people that are known or unknown to the person hearing them.

Delusions. These are false beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.

Negative symptoms are ones that diminish a person’s abilities. Negative symptoms often include being emotionally flat or speaking in a dull, disconnected way. People with the negative symptoms may be unable to start or follow through with activities, show little interest in life, or sustain relationships. Negative symptoms are sometimes confused with clinical depression.

Cognitive issues/disorganized thinking. People with the cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts or complete tasks. Commonly, people with schizophrenia have anosognosia or “lack of insight.” This means the person is unaware that he has the illness, which can make treating or working with him much more challenging.

Causes

Research suggests that schizophrenia may have several possible causes:

• Genetics. Schizophrenia isn’t caused by just one genetic variation, but a complex interplay of genetics and environmental influences. Heredity does play a strong role—your likelihood of developing schizophrenia is more than six times higher if you have a close relative, such as a parent or sibling, with the disorder
• Environment. Exposure to viruses or malnutrition before birth, particularly in the first and second trimesters has been shown to increase the risk of schizophrenia. Recent research also suggests a relationship between autoimmune disorders and the development of psychosis.
• Brain chemistry. Problems with certain brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neurotransmitters allow brain cells to communicate with each other. Networks of neurons are likely involved as well.
• Substance use. Some studies have suggested that taking mind-altering drugs during teen years and young adulthood can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana increases the risk of psychotic incidents and the risk of ongoing psychotic experiences. The younger and more frequent the use, the greater the risk.

Diagnosis

Diagnosing schizophrenia is not easy. Sometimes using drugs, such as methamphetamines or LSD, can cause a person to have schizophrenia-like symptoms. The difficulty of diagnosing this illness is compounded by the fact that many people who are diagnosed do not believe they have it. Lack of awareness is a common symptom of people diagnosed with schizophrenia and greatly complicates treatment.

While there is no single physical or lab test that can diagnosis schizophrenia, a health care provider who evaluates the symptoms and the course of a person’s illness over six months can help ensure a correct diagnosis. The health care provider must rule out other factors such as brain tumors, possible medical conditions and other psychiatric diagnoses, such as bipolar disorder.

To be diagnosed with schizophrenia, a person must have two or more of the following symptoms occurring persistently in the context of reduced functioning:

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized or catatonic behavior
• Negative symptoms

Delusions or hallucinations alone can often be enough to lead to a diagnosis of schizophrenia. Identifying it as early as possible greatly improves a person’s chances of managing the illness, reducing psychotic episodes, and recovering. People who receive good care during their first psychotic episode are admitted to the hospital less often, and may require less time to control symptoms than those who don’t receive immediate help. The literature on the role of medicines early in treatment is evolving, but we do know that psychotherapy is essential.

People can describe symptoms in a variety of ways. How a person describes symptoms often depends on the cultural lens she is looking through. African Americans and Latinos are more likely to be misdiagnosed, potentially due to differing cultural perspectives or structural barriers. Any person who has been diagnosed with schizophrenia should try to work with a health care professional that understands his or her cultural background and shares the same expectations for treatment.

Related Conditions

People with schizophrenia may have additional illnesses. These may include:

• Substance use disorders/ Dual Diagnosis
• Posttraumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Major depressive disorder

Successfully treating schizohprenia almost always improves these related illnesses. And successful treatment of substance misuse, PTSD or OCD usually improves the symptoms of schizophrenia.

Treatment

With medication, psychosocial rehabilitation, and family support, the symptoms of schizophrenia can be reduced. People with schizophrenia should get treatment as soon as the illness starts showing, because early detection can reduce the severity of their symptoms.

Recovery while living with schizophrenia is often seen over time, and involves a variety of factors including self-learning, peer support, school and work and finding the right supports and treatment.

Medication

Typically, a health care provider will prescribe antipsychotics to relieve symptoms of psychosis, such as delusions and hallucinations. Due to lack of awareness of having an illness and the serious side effects of medication used to treat schizophrenia, people who have been prescribed them are often hesitant to take them.

First Generation (Typical) Antipsychotics

These medications can cause serious movement problems that can be short (dystonia) or long term (called tardive dyskinesia), and also muscle stiffness. Other side effects can also occur.

• Chlorpromazine (Thorazine)
• Fluphenazine (Proxlixin)
• Haloperidol (Haldol)
• Loxapine (Loxitane)
• Perphenazine (Trilafon)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)

Second Generation (Atypical) Antipsychotics

These medications are called atypical because they are less likely to block dopamine and cause movement disorders. They do, however, increase the risk of weight gain and diabetes. Changes in nutrition and exercise, and possibly medication intervention, can help address these side effects.

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Clozapine (Clozaril)
• Iloperidone (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)

One unique second generation antipsychotic medication is called clozapine. It is the only FDA approved antipsychotic medication for the treatment of refractory schizophrenia and has been the only one indicated to reduce thoughts of suicide. However, it does have multiple medical risks in addition to these benefits.

Psychotherapy

Cognitive behavioral therapy (CBT) is an effective treatment for some people with affective disorders. With more serious conditions, including those with psychosis, additional cognitive therapy is added to basic CBT (CBTp). CBTp helps people develop coping strategies for persistent symptoms that do not respond to medicine.

Supportive psychotherapy is used to help a person process his experience and to support him in coping while living with schizophrenia. It is not designed to uncover childhood experiences or activate traumatic experiences, but is rather focused on the here and now.

Cognitive Enhancement Therapy (CET) works to promote cognitive functioning and confidence in one’s cognitive ability. CET involves a combination of computer based brain training and group sessions. This is an active area of research in the field at this time.

Psychosocial Treatments

People who engage in therapeutic interventions often see improvement, and experience greater mental stability. Psychosocial treatments enable people to compensate for or eliminate the barriers caused by their schizophrenia and learn to live successfully. If a person participates in psychosocial rehabilitation, she is more likely to continue taking their medication and less likely to relapse. Some of the more common psychosocial treatments include:

• Assertive Community Treatment (ACT) provides comprehensive treatment for people with serious mental illnesses, such as schizophrenia. Unlike other community-based programs that connect people with mental health or other services, ACT provides highly individualized services directly to people with mental illness. Professionals work with people with schizophrenia and help them meet the challenges of daily life. ACT professionals also address problems proactively, prevent crises, and ensure medications are taken.
• Peer support groups like NAMI Peer-to-Peer encourage people’s involvement in their recovery by helping them work on social skills with others.

Complementary Health Approaches

Complementary and alternative health approaches including acupuncture, meditation, and nutrition interventions can be part of a comprehensive treatment plan. For example, Omega-3 fatty acids, commonly found in fish oil, have shown some promise for treating and managing schizophrenia. Some researchers believe that omega-3 may help treat mental illness because of its ability to help replenish neurons and connections in affected areas of the brain.

Additional Concerns

Physical Health. People with schizophrenia are subject to many medical risks, including diabetes and cardiovascular problems, and also smoking and lung disease. For this reason, coordinated and active attention to medical risks is essential.

Substance Use. People with schizophrenia are at an increased risk for misusing drugs or alcohol. Substance use can make the treatments for schizophrenia less effective, make people less likely to follow their treatment plans, and even worsen their symptoms.

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• How My Relationships with My Caregivers Has Helped Me Navigate Schizoaffective Disorder

Support

Coping with schizophrenia isn’t easy. But if you or a family member or friend is struggling, there is help. NAMI and NAMI Affiliates are here to provide you with support for you and your family and information about community resources. Contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org if you have any questions about schizophrenia or finding support and resources.

Helping Yourself

If you have schizophrenia, the condition can exert control over your thoughts, interfere with functioning and if not treated, lead to a crisis. Here are some ways to help manage your illness.

• Manage Stress. Stress can trigger psychosis and make the symptoms of schizophrenia worse, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.
• Try to get plenty of sleep. When you’re on medication, you most likely need even more sleep than the standard eight hours. Many people with schizophrenia have trouble with sleep, but lifestyle changes such as getting regular exercise and avoiding caffeine can help.
• Avoid alcohol and drugs. Substance use affects the benefits of medication and worsens symptoms. If you have a substance use problem, seek help.
• Maintain connections. Having friends and family involved in your treatment plan can go a long way towards recovery. People living with schizophrenia often have a difficult time in social situations, so surrounding yourself with people who understand this can make the transition back into daily social life smoother. If you feel you can, consider joining a schizophrenia support group or getting involved with a local church, club, or other organization.

If you live with a mental health condition, learn more about managing your mental health and finding the support you need.

Helping A Family Member Or Friend

Learning about psychosis and schizophrenia will help you understand what your friend or family member is experiencing and trying to cope with. Living with schizophrenia is challenging. Here are some ways you can show support:

• Respond calmly. To your loved one, the hallucinations seem real, so it doesn’t help to say they are imaginary. Calmly explain that you see things differently. Being respectful without tolerating dangerous or inappropriate behavior.
• Pay attention to triggers. You can help your family member or friend understand, and try to avoid, the situations that trigger his or her symptoms or cause a relapse or disrupt normal activities.
• Help ensure medications are taken as prescribed. Many people question whether they still need the medication when they’re feeling better, or if they don’t like the side effects. Encourage your loved one to take his or her medication regularly to prevent symptoms from coming back or getting worse.
• Understanding lack of awareness (anosognosia). Your family member or friend one may be unable to see that he or she has schizophrenia. Rather than trying to convince the person he or she has schizophrenia, you can show support by helping him or her be safe, get therapy, and take the prescribed medications.
• Help avoid drugs or alcohol. These substances are known to worsen schizophrenia symptoms and trigger psychosis. If your loved one develops a substance use disorder, getting help is essential.

Find out more about taking care of your family member or friend and yourself.

• Power of Connection: Co-facilitating a NAMI Support Group
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